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What is Minimal Residual Disease (MRD)?

After treatment, there may be a small number of cancer cells that remain in the body. This is referred to as minimal residual disease (MRD). The remaining number of cells may be so small that they do not cause any physical signs or symptoms..

They usually go undetected through traditional methods, such as viewing cells under a microscope or by checking for abnormal serum proteins in the blood. If a patient receives a MRD positive test result, it means that residual (remaining) cancer cells have been detected. A negative result means that no residual disease is detected.
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What role does Minimal Residual Disease (MRD) assessment play in-patient care?

Any remaining cancer cells can become active and begin to multiply, causing the patient to relapse. MRD assessment helps indicate if the treatment was not completely effective. Minimal residual disease might be present after treatment because not all the cancer cells responded to therapy.
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Is a negative MRD result a positive sign?

A positive test result for MRD, known as “MRD positivity”, indicates that residual cancer cells are present in the body after treatment. When a patient tests negative for minimal residual disease, known as “MRD negativity”, there are no remaining cancer cells..

Being “MRD negative” is an encouraging outcome for a patient with blood cancer. MRD negativity means that even with advanced, sensitive tests, no cancer cells were detected. According to studies, MRD negativity is associated with longer remissions and potentially longer rates of survival for certain blood cancers.

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How does MRD testing affect my treatment?

 

Testing for MRD can help our treatment team distinguish between patients who need additional or different treatment from those who do not. This knowledge can also guide treatment decisions and improve patient outcomes..

Minimal residual disease testing helps:

  • Show how well cancer has responded to treatment
  • Confirm and monitor remissions
  • Detect cancer recurrence sooner than other tests
  • Identify a higher risk of relapse in patients
  • Identify the need to restart treatment
  • Identify patients who are candidates for procedures such as stem cell transplantation or combination therapy.
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When would doctors test for MRD?

Testing for MRD in patients is dependent on varying factors specific to the patient’s disease..

Patients may be tested:

  • After bone marrow transplantation.
  • After the last cycle of a planned combination therapy.
  • During treatment.
  • After one year of maintenance therapy.
  • To confirm the depth of remission.
  • At regular intervals, once treatment is completed.
  • At other specific times.
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What are the techniques used to detect MRD?

MRD testing uses highly sensitive methods such as flow cytometry, polymerase chain reaction (PCR), and next-generation sequencing (NGS). Each of these tests uses bone marrow cell samples taken through aspiration, or peripheral blood cells taken through a vein.
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MRD Testing in Specific Blood Cancers

The type of MRD testing used depends on the type of blood cancer.

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 Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML)

For patients with ALL and AML, MRD is detected through flow cytometry, PCR, and NGS.

 
  
  • When treating paediatric and adult ALL and AML, MRD is part of routine testing.
  • MRD can predict the effectiveness of a specific treatment after the induction phase of ALL and AML treatment.
  • MRD can identify patients who are at higher risk of relapse. This allows administration of earlier or alternative therapies. MRD can determine patients who may benefit from a bone marrow transplantation.
 

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 Chronic Lymphocytic Leukaemia (CLL)

For patients with CLL, MRD is detected by flow cytometry and PCR.

 
  
  • MRD negativity in patients after CLL therapy may have better treatment outcomes.
  • MRD positivity in patients after treatment are potential candidates for treatment intensification, consolidation and maintenance strategies.
 

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 Chronic Myeloid Leukaemia (CML)

For patients with CML, MRD is detected through PCR.

 
  
  • PCR can detect the Philadelphia (Ph) chromosome found in 95% of CML patients.
  • PCR can detect one Ph+ CML cell in one million healthy cells.
  • MRD monitoring helps predict resistance to treatment and guide the course of the patient’s treatment.
 

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 Lymphoma

For patients with lymphoma, MRD is detected through flow cytometry and PCR.

 
  
  • MRD testing can detect patients who are at risk of relapsing, allowing them to receive additional treatment.
  • MRD testing is used in follicular, mantle cell and diffuse large B-cell lymphoma (DLBCL).
  • Patients treated for mantle cell lymphoma and achieve MRD negativity have shown to have prolonged remissions.
  • Studies have demonstrated that DLBCL patients who achieved remission and MRD negativity after treatment were more likely to remain in remission compared to patients who had achieved remission with MRD positivity.
 

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 Myeloma

For patients with myeloma, MRD testing uses flow cytometry, NGS, and imaging tests.

 
  
  • PET-CT scans combined with other tests help doctors find disease present outside the bone marrow.
  • Patients who achieve MRD negativity after treatment live longer without disease progression, according to several studies.
 

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FAQs

Depending on the condition, restarting treatment again such as chemotherapy, radiotherapy or immunotherapy may be required. After detecting minimal residual disease, some patients may be candidates for stem cell transplantation or combination therapy.

While 80-90% of children and young adults will respond to initial ALL treatment, it is estimated that approximately 10-15% will experience disease relapse. For adults, the risk of disease relapse is even higher at 40-50%.

While high-grade Lymphomas tend to progress more rapidly, a good proportion of high-grade Lymphomas can be effectively treated with a low risk of relapse.

Low-grade Lymphomas often respond well to treatments available. However, they are not usually cured and may recur eventually over time.

Acute myeloid leukaemia is an aggressive and fast-growing cancer. A patient’s outcome depends on the type of AML they are diagnosed with, their individual health, and recommended treatment plan. 

While many cases of AML can be cured with treatment such as chemotherapy or a bone marrow transplant, the outcomes still depend on the patient’s age and fitness, as well as the AML risk groups.

For patients with standard risk AML, approximately 50% of patients may be successfully treated with existing treatments. For patients with favourable risk AML, approximately 60-70% of patients may have a durable remission. However, for patients with poor risk AML, the chances of a durable remission are less than 25%.

While there is, unfortunately, no cure for multiple myeloma currently, treatment such as chemotherapy and immunotherapy, amongst others, can be used to successfully manage the condition for years. 

With the introduction of novel drug therapies, as well as the use of 3-4 drug combinations for upfront treatment of myeloma, the majority of newly diagnosed myeloma patients are able to achieve a partial or complete response to initial therapy.

Many of these patients will eventually relapse over time. Treatment strategies such as the use of autologous stem cell transplantation, as well as the use of longer term maintenance therapy have been adopted successfully to delay the time to relapse (ie. prolong the disease free interval)  

These approaches do not factor in variables such as age and overall health. Speak to our doctor for a better understanding of the success rates of your treatment plan.

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Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

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        Contact Us

    Locations

    Contact

    WhatsApp : +65 6256 8836
    Email : contact@cfch.com.sg
    .

    Consultation Hours

    Monday to Friday : 8.30am – 5.30pm
    Saturday : 8.30am – 12.30pm
    Closed on Sunday & Public Holidays

    Find us on Facebook

    Drop a Line

    If you have any questions about your condition or would like to make an appointment, simply fill up the form and we'll contact you as soon as we can

      Disclaimer | 2023 Centre For Clinical Haematology | Website Created by Cleveraa